Holmium versus bipolar en bloc transurethral resection of urinary bladder tumors: a randomized controlled trial.

INTRODUCTION

The study evaluated the safety, efficacy, and pathological outcomes of holmium laser en bloc resection of bladder tumor (HoL-ERBT) vs bipolar en bloc resection of bladder tumor (Bp-ERBT).

MATERIAL AND

METHODS

Adult patients with bladder masses less than 5 cm with no signs of extravesical extension on preoperative imaging were included in our study and were randomly allocated to two equal groups representing HoL-ERBT and Bp-ERBT. The primary outcome was the conversion rate of the surgical technique in each group to either conventional resection or using another energy source. Secondary outcomes were perioperative complications and pathological evaluation outcomes in each group.

RESULTS

Ninety-four patients were finally evaluated in our study. Demographic data and tumor characteristics were comparable between the two groups. The surgical conversion rate was higher in the Bp-ERBT group (9 cases) compared to the HoL-ERBT group (4 cases) (p = 0.038). No obturator nerve reflex was observed in the HoL-ERBT group compared to 8 cases in the Bp-ERBT group. Perioperative complications were comparable between the two groups. Pathological assessment revealed better T1 substaging and fewer thermal artifacts in the HoL-ERBT group (p-value 0.011 and 0.027, respectively).

CONCLUSIONS

Both holmium laser and bipolar energy sources are safe and effective in en bloc bladder tumor resection. HoL-ERBT showed a superior safety profile with no occurrence of ONR and a lower conversion rate, and offers an enhanced tumor pathological assessment regarding T1 substaging and the artifact score.